基于JCI标准的疼痛管理模式对全髋关节置换术患者围手术期疼痛程度的影响

The effect of JCI-based pain management on the perioperative pain level in patients underwent total hip arthroplasty

目的探讨基于国际医院联合委员会(JCI)标准的疼痛管理模式对全髋关节置换术患者围手术期疼痛程度、髋关节功能恢复、心理状态的影响。方法选取2015年1月—2018年1月南阳市某医院收治的全髋关节置换术患者104例为研究对象,采用随机数字表法分为对照组和观察组,各52例。对照组患者采用常规护理干预,观察组患者采用基于JCI标准的疼痛管理模式干预,2组患者持续干预至出院。比较2组患者术前与术后6 h、12 h、24 h、48 h白细胞介素-6(IL-6)、P物质(SP)水平、疼痛数字评价量表(NRS)评分,比较2组患者术前与术后48 h焦虑抑郁状态[汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)],比较2组患者干预前与出院后3个月、6个月、9个月、12个月时的髋关节功能,比较2组患者干预过程中不良反应发生情况。结果术后6 h、12 h、24 h,2组患者血清IL-6、SP水平及NRS评分均高于术前,差异均有统计学意义(P<0.05)。术后6 h、12 h、24 h,观察组患者血清IL-6、SP水平及NRS评分均低于对照组,差异均有统计学意义(P<0.05)。术后48 h,2组患者HAMA评分、HAMD评分均低于术前,且观察组低于对照组,差异均有统计学意义(P<0.05)。与术后3个月相比,2组患者在术后6个月、9个月、12个月时的Harris髋关节功能评分均升高,且观察组高于对照组,差异均有统计学意义(P<0.05)。观察组患者护理期间不良反应发生率为11.54%,低于对照组的28.85%,差异有统计学意义(P<0.05)。结论基于JCI标准的疼痛管理模式可显著降低全髋关节置换术患者围手术期IL-6、SP水平,降低术后疼痛程度,缓解术后焦虑、抑郁情绪,促进术后髋关节功能恢复,值得在临床上推广使用。

Objective To explore the effect of Joint Commission International(JCI)-based pain management on perioperative pain level,hip function and psychological status in patients underwent total hip arthroplasty.Methods A total of 104 patients receiving total hip arthroplasty admitted to a hospital in Nanyang City from January 2015 to January 2018 were selected as subjects,who were assigned to a control group and an observation group via the random number table method,with 52 cases in each group.Patients in the control group received conventional nursing interventions,while patients in the observation group received pain management interventions based on JCI standards,and patients in the 2 groups received continuous interventions until discharge.The preoperative and postoperative levels of interleukin-6(IL-6),substance P(SP),and Numerical Rating Scale(NRS)scores at 6 h,12 h,24 h,and 48 h were compared between the two groups.The anxiety and depression status[Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD)]at 48 h before and after the intervention were compared between the two groups.The hip function of patients in the two groups at 3 months,6 months,9 months and 12 months after discharge were compared to that before interventions,and the incidence of adverse reactions during the intervention were compared between the 2 groups.Results The IL-6,SP levels and NRS scores of patients in both groups at 6 h,12 h and 24 h after surgery were higher than those before surgery,and the differences were statistically significant(P<0.05).The IL-6,SP levels and NRS scores of patients at 6 h,12 h and 24 h after surgery in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The HAMA and HAMD scores of patients at 48 h after surgery in both groups were lower than those before surgery,with scores in the observation group lower than those in the control group and the differences were statistically significant(P<0.05).The Harris hip function scores of patients in both groups were higher at 6,9 and 12 months after surgery than those at 3 months after surgery,with scores in the observation group higher than those in the control group,and the differences were statistically significant(P<0.05).The incidence of adverse reactions during nursing was 11.54%in the observation group,which was lower than that in the control group(28.85%),and the difference was statistically significant(P<0.05).Conclusion The pain management based on JCI standards can significantly reduce the perioperative IL-6 and SP levels in patients underwent total hip arthroplasty,decrease the degree of postoperative pain,alleviate postoperative anxiety and depression,and promote the recovery of postoperative hip function.These advantages justify a wider application of this model clinically.